Glaucoma check-ups lag in Hispanics

NEW YORK (Reuters Health) - In a new study of U.S. adults with glaucoma, Hispanics were the least likely to get routine follow-up testing to make sure their vision wasn't getting worse.

With glaucoma, pressure inside the eye builds up over time, causing damage to the optic nerve.

Many people start off with no symptoms and are treated with eye drops. But the condition calls for regular check-ups to make sure patients haven't started developing irreversible eye damage, which can lead to blindness.

"For persons who have glaucoma, those who are considered 'glaucoma suspects,' or are at increased risk for the disease because of family history or other factors, it is important to seek eye care and follow up regularly with an eye care professional," lead researcher Dr. Joshua Stein told Reuters Health by email.

Most people who've already been diagnosed with glaucoma should have follow-up tests every six to 15 months, said Stein, a glaucoma specialist and health sciences researcher at the University of Michigan Kellogg Eye Center in Ann Arbor.

He said differences in check-ups by race and ethnicity may have to do with doctor-patient relationships in addition to how well people understand their condition and its management.

For the new study, Stein and his colleagues tracked a group of adults with glaucoma who were covered by private health insurance. They focused on people diagnosed in 2003 or 2007 who had at least two years worth of follow-up medical claims - about 4,000 people each year.

In 2003, Hispanics were less likely than white, black or Asian patients to get any of three common glaucoma check-ups, including tests of central and peripheral vision and photos of the interior surface of the eye. Over the two years following their diagnosis, one-quarter of them had no additional testing, compared to between 16 and 21 percent of patients of other races.

Those figures improved by 2007, when between 10 and 15 percent of people of each race had no follow-up testing during the next two years. But gains for Hispanic patients still lagged behind others on some measures, Stein's team reported this week in the Archives of Ophthalmology.

About three million people in the U.S. have glaucoma, and the risk increases with age.

Stein's team noted that racial disparities in its study group were likely minimized because everyone had health insurance - and minorities are more likely than whites to be uninsured or underinsured.

Dr. Susannah Rowe, an ophthalmologist from the Boston Medical Center, said she was "encouraged" to see that black people with glaucoma in the new report were typically getting regular check-ups.

"The eye care community has become much more focused on earlier diagnosis and better treatment of black Americans," Rowe, who wasn't involved in the research, told Reuters Health. It's known that blacks develop glaucoma earlier than whites, she said, and that their disease is harder to treat.

But, "There's been less awareness of the frequency of glaucoma in Latino patients," she added.

Providing translators and Spanish language materials could help reach Hispanic patients, as could "cultural competency" training for doctors and medical students, said Dr. Eve Higginbotham, a visiting scholar at the Association of American Medical Colleges in Washington, DC.

"Certainly given the numbers of Latinos and Latinas that we have in our country, and it's a growing number of course, it's a matter of actually sensitizing practitioners to the needs of this population," Higginbotham, who wrote an editorial published with the study, told Reuters Health.

She said it's also important for patients, themselves, to be proactive about their own care and talk to their doctor about how their glaucoma is being managed.

Getting them in the door is a good first step, according to Rowe.

"The most important thing will be to continue to improve access to good quality eye care and to insurance that covers that care," she said.